Certified Provider Credentialing Specialist (CPCS) Study Guide Exam!!

Certified Provider Credentialing Specialist (CPCS)
Study Guide Exam!!


Certified Provider Credentialing Specialist - ANSWER The Certified Provider
Credentialing Specialist (CPCS) is usually employed or contracted by a healthcare
organization including, but not limited to, hospitals, health systems, health plans,
ambulatory care settings, groups, practices and credentialing verification
organizations.



Initial Appointment / Clinical privileges/ practioners covered according to the TJC -
ANSWER All licensed Independent practitioners must be credentialed and privileged
through the organized Medical staff structure



Initial Appointment / Clinical privileges/ practioners covered according to the NCQA -
ANSWER HP's and MBHO's have to have documented Credentialing policies and
procedures which applies to all practitioners providing care to the organizations
members.



Initial Appointment / Clinical privileges/ practioners covered according to CMS -
ANSWER The Governing body determines, in accordance with Staye Law, which
categories of practitioners are eligible for appointment to the medical staff. At a
minimum the medical staff must be composed of MD 's and DO's.



Verification of Medical education according to the TJC - ANSWER Requires verification
from the medical school or accepted PSV



TJC Accepted PSV for medical education - ANSWER The AMA, the AOA, and the
ECFMG



Verification of Medical education according to the NCQA - ANSWER Requires HP/CVO
the highest of three levels of education and training.

, The three levels of education and training as defined by NCQA - ANSWER Graduation
from medical or professional school, residency, board certification.



Verification of Medical education as per CMS - ANSWER The medical staff should have
a procedure to verify the documentation for professional education



Verification of postgraduate training according to TJC - ANSWER must be verified
from source or sources designated as equivalent by source



TJC accepted PSV for postgraduate training - ANSWER AMA and AOA



Verification of postgraduate training according to NCQA - ANSWER The highest of the
three levels of education and training attained. If board certified, than board
certification suffices.



Verification of postgraduate training according to CMS - ANSWER The medical staff
must have a mechanism to examine evidence of training and documented experiences.



TJC requires verification of board certification - ANSWER The TJC standards do not
require board certification verification, if the medical staff bylaws, policies or rules and
regulations require certification. It is, however an expectation that in some manner,
board certification will be verified.



NCQA does not require board certification. If the individual is board certified verification
may be obtained directly form the specialty board, AMA, or AOA.



ABMS certified Doctor Verification - ANSWER Not recognized by the NCQA as a
source for verification of board certification. The site is a consumer reference only



Board Certification verification -CMS- ANSWER There is no mention in the CMS
standards regarding board certification. Medical staff cannot rely only on board
certification and needs to address all training elements as well as professional
education.